Cho Thomas, Waters Amy, Senthilkumar Shiva, Shendge Shradha, Liu Jiayong
Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.
Ann Jt. 2024 Sep 6;9:36. doi: 10.21037/aoj-24-14. eCollection 2024.
Syndesmotic ankle fractures occur when there is damage to the syndesmosis complex, resulting in severe pain and instability. Treatment methods include static fixation, dynamic fixation, and fibular nailing. This systematic review and meta-analysis aims to compare the outcomes of these surgical interventions for syndesmotic ankle fractures.
PubMed and Embase were searched up until April 2024 for comparison studies that included at least two of the treatment methods and relevant functional outcomes and complication metrics. Review Manager 5.4 was used for statistical analyses, and a P value ≤0.05 was considered statistically significant. Risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale.
Nineteen studies with a total of 1,182 patients met the inclusion criteria. Compared to static fixation, dynamic fixation had a significantly higher Olerud-Molander Ankle Score (OMAS) at both 1-year [standardized mean difference (SMD) =0.43; 95% confidence interval (CI): 0.22 to 0.65; P<0.05] and 2-year post-operation (SMD =0.76; 95% CI: 0.33 to 1.20; P<0.05). Dynamic fixation had a significantly lower reoperation rate than static fixation [risk ratio (RR) =0.55; 95% CI: 0.36 to 0.83; P=0.004]. Compared to static fixation, fibular nail had a significantly higher OMAS at 1-year post-operation (SMD =0.28; 95% CI: 0.03 to 0.53; P=0.03). Fibular nails had significantly lower infection (RR =0.12; 95% CI: 0.04 to 0.37; P<0.05) and reoperation rates (RR =0.22; 95% CI: 0.06 to 0.86; P=0.03) than static fixation. Compared to fibular nail, dynamic fixation had a significantly higher OMAS at both 1-year (SMD =1.07; 95% CI: 0.83 to 1.31; P<0.05) and 2-year post-operation (SMD =1.03; 95% CI: 0.60 to 1.47; P<0.05). Dynamic fixation had a significantly higher reoperation rate compared to fibular nail (RR =20.41; 95% CI: 2.81 to 148.21; P=0.003).
Dynamic fixation seems to be the superior treatment method, displaying better outcomes than static fixation and fibular nailing, with the fibular nail proving to be a viable alternative. Dynamic fixation should be the first choice of treatment for those with syndesmotic ankle fractures due to its clinical advantages compared to static fixation and fibular nailing.
下胫腓联合踝关节骨折是指下胫腓联合复合体受损，导致严重疼痛和不稳定。治疗方法包括静力固定、动力固定和腓骨钉固定。本系统评价和荟萃分析旨在比较这些手术干预治疗下胫腓联合踝关节骨折的效果。
检索截至2024年4月的PubMed和Embase数据库，查找至少包含两种治疗方法以及相关功能结局和并发症指标的比较研究。使用Review Manager 5.4进行统计分析，P值≤0.05被认为具有统计学意义。采用Review Manager 5.4和纽卡斯尔-渥太华量表评估偏倚风险。
19项研究共1182例患者符合纳入标准。与静力固定相比，动力固定在术后1年[标准化均数差（SMD）=0.43；95%置信区间（CI）：0.22至0.65；P<0.05]和2年时的Olerud-Molander踝关节评分（OMAS）显著更高（SMD =0.76；95%CI：0.33至1.20；P<0.05）。动力固定的再次手术率显著低于静力固定[风险比（RR）=0.55；95%CI：0.36至0.83；P=0.004]。与静力固定相比，腓骨钉在术后1年时的OMAS显著更高（SMD =0.28；95%CI：0.03至0.53；P=0.03）。腓骨钉的感染率（RR =0.12；95%CI：0.04至0.37；P<0.05）和再次手术率（RR =0.22；95%CI：0.06至0.86；P=0.03）显著低于静力固定。与腓骨钉相比，动力固定在术后1年（SMD =1.07；95%CI：0.83至1.31；P<0.05）和2年时的OMAS显著更高（SMD =1.03；95%CI：0.60至1.47；P<0.05）。动力固定的再次手术率显著高于腓骨钉（RR =20.41；95%CI：2.81至148.21；P=0.003）。
动力固定似乎是更优的治疗方法，其效果优于静力固定和腓骨钉固定，腓骨钉是一种可行的替代方法。由于与静力固定和腓骨钉固定相比具有临床优势，动力固定应作为下胫腓联合踝关节骨折患者的首选治疗方法。
3级
